Medicare Provider Status Recognition

Pharmacy’s Top Priority: Medicare Provider Status Recognition

The profession’s flagship legislation, the Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 2759/S. 1362 , was introduced in the U.S. House of Representatives on April 22, 2021 and the U.S. Senate on April 26, 2021. APhA and its members will vigorously advocate for passage and enactment of the bill, known in the pharmacy community as “provider status.”

The Legislation

We call on Congress to improve patients’ access to health care by passing the Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 2759/S. 1362. The bill would add pharmacists to the list of providers whose patient care services, when delivered to patients in medically underserved communities, are covered by Medicare Part B (i.e., grant them “provider status”). The legislation would ensure that pharmacists are fairly compensated for the valuable patient care they provide to beneficiaries who struggle to access basic health care services.

Read the legislation on congress.gov

APhA Statement

Pharmacists offer services well beyond dispensing medications, and each state has its own scope of practice law that outlines which services they are authorized to provide. If Congress passed the Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 2759/S. 1362 , pharmacists could bill Medicare Part B for services within their states’ scope of practice. Although they vary from state to state, these services generally include medication management, point-of-care testing, immunizations, and chronic disease management.

Read the APhA statement

Recognizing pharmacists as providers

Evidence shows that pharmacists make a significant impact on patients’ health outcomes and overall health and reduce health care costs. Provider status would align reimbursement with the services pharmacists are trained to provide and give underserved patients more access to crucial care.

Provider status legislation would

allow pharmacists in underserved areas to bill Medicare Part B for services within pharmacists’ state scope of practice delivered to Medicare beneficiaries
and be reimbursed at 85% of the physician fee schedule.

Provider status legislation would not

apply to all Medicare Part B beneficiaries, or
grant pharmacists new practice authorities. It would only increase access to already-authorized services.

Take Action Now: Be a Provider Status Advocate

Contact Congress

Use APhA’s pre-written, editable advocacy alert to ask your U.S. Senators and Representative to cosponsor the Pharmacy and Medically Underserved Areas Enhancement Act, H.R. 2759/S. 1362 , or thank them if they have already signed on .

Contact Congress

Meet With Your Legislators

Ask to meet virtually with your representative to explain the impact the bill can make on their constituents and why this issue is important to you.

How to Schedule an Appointment

Spread the Word

Use these Quick Facts to explain how authorizing pharmacists to bill for patient care services under Medicare Part B improves access to health care and improves outcomes in underserved communities.

Explore the Fact Sheet